Interacting with NGOs to reduce chronic disease risks

Speaking notes

Our goal here is simple; to see how WHO can work most effectively with civil society to curb the growing toll of ill health, death and disability from chronic diseases.

Our world is in transition. Societies all over the world are becoming more urbanized. Populations are ageing. Physical activity levels are declining as people adapt to more sedentary lifestyles. We see a major shift away from traditional diets, and the increased consumption of energy-dense diets with high levels of fats and sugars, as well as salt. The consumption of fruit and vegetables is also going down. All these factors, as well as tobacco use, have dramatically changed the global profile of disease. Noncommunicable conditions now account for approximately 60 per cent of the 56.5 million global deaths annually.

The World Health Report 2002 identified high blood pressure, high cholesterol, obesity, alcohol and tobacco as five of the top 10 global disease burden risk factors. Independently, and often in combination, these are the major causes of chronic diseases. It is important to note that this is not simply an obesity issue; high blood pressure and high cholesterol caused by unbalanced diets can exist regardless of the patient’s weight.

These realities make Noncommunicable Disease control a priority for WHO and its Member States. Concern for this public health issue in many cases is brought to governments’ attention by NGOs like yours. The evidence of the changing disease burden is clear. The risk factors are known as well as the evidence about effective preventive measures.

This World Health Assembly will see the adoption of the WHO Framework Convention on Tobacco Control. We are now actively addressing two other major risks: unhealthy diet and physical inactivity. We acknowledge your expertise in this area, and we strongly value your continuing support for WHO’s efforts.

Last month, the Joint WHO/Food and Agricultural Organization Expert Consultation report, Diet, Nutrition and the Prevention of Chronic Diseases, was formally issued in Rome by FAO Director-General Jacques Diouf and myself. The Report addresses the major chronic diseases and emphasizes that a diet low in saturated fats, sugars and salt, and high in vegetables and fruits, together with an increase in physical activity, will have a major impact on this high toll of death and disease.

You are all familiar with the Report’s recommendations. And little of this is new to you; these are issues you have been working to bring to the attention of global policymakers for many years. What is new, however, is that the Report has come at a time when WHO is developing a policy response to the crucial issue of the chronic disease burden. We are now in a strong position to advise our Member States on the current state of nutritional science relating to chronic diseases.

Moving from evidence to action poses an enormous challenge. National action by governments is an important starting point, and can be very effective. But, in an increasingly globalized and interdependent world, we believe WHO’s goals can only be met through broader, multi-sectoral involvement with diverse stakeholders. This was the mandate given to us by our Member States when, in May last year, the World Health Assembly asked us to develop a Global Strategy on Diet, Physical Activity and Health in consultation – not only with Member States and UN agencies – but in collaboration with the private sector and civil society. Which is why we are here today.

NGOs play a key role in shifting and influencing consumer demand, as well as national and international political priorities. I believe we will only succeed in effecting change – nationally and globally – if civil society can effectively work with governments to make health for all peoples a priority. To ensure that your voice is heard we have to work closely together. Messages about diet and physical activity need to be focused, realistic and clear.

But achieving this simple, shared goal, is a complex and demanding exercise. In order to succeed, we need to ensure that all stakeholders – civil society, industry, governments and international agencies such as ours – work constructively together for the greater public good. As you know, I met last week with senior executives from the food industry. We believe that these companies can make a major contribution towards easing this burden and promoting healthier diets and lifestyles. The food industry is clearly part of the solution.

WHO interaction with the private sector has ranged from our condemnation of tobacco, which is lethal in its consequences, to our efforts to increase the consumption of fruit and vegetables, which are clearly beneficial. The question for you to consider is where, in this spectrum, do you see the food industry?

Some of you, I know, wish to see us push for a strong charter on food. However, while our past shared experience on issues such as tobacco and infant feeding have provided us with some useful guidelines, we need to recognize that food, in its complexity, is not tobacco, nor is it similar to infant feeding. Shifting the pattern of diet and physical activity behaviour across the global population demands a more nuanced and multifaceted approach than that adopted for tobacco. We intend to pursue a constructive dialogue with all parties to develop a strategy that most effectively can address these complex issues.

I told the private sector, as I have told you, that we recognize that food is not tobacco. However, I reminded them that they have a responsibility, on a global basis, to ensure that healthy choices become easy choices for their consumers.

WHO interaction with the private sector is about promoting health. We have to safeguard the integrity of the policy-making process to protect ourselves from real or perceived conflicts of interest. Our interaction must be transparent and accountable. And, of course, WHO does not endorse companies or products. We weigh with great care the potential gains of interacting with various stakeholders, against any real and perceived risks.

We do want to find ways to welcome efforts by companies to align their actions with WHO’s policies and guidelines. We also understand that companies need a predictable regulatory environment, and one which provides incentives to develop foods that meet the nutrient goals, recommended by our experts. We are also seeing a wide range of views on this issue within the food industry.

The response in last week’s meeting was positive and constructive, and we have agreed to continue our dialogue. The goals are clear: Our science shows that changes are needed in the fat, sugar and salt levels of many foods, and we want to see increased consumption of fruits and vegetables and more physical activity. We were also clear about our expectation that industry needs to review its approaches to marketing to young children, where this adversely affects their diets.

We agreed to follow up on some key issues of concern: communication of effective messages, product development, food labelling and health claims and marketing to children. We are still considering carefully what will be our next steps. But we already know that civil society will have to be part of these next steps.

Our Member States are key in developing the Strategy. We have so far held five of our six regional consultations. Our meetings have reaffirmed both the importance of what we are doing, and the range of different problems countries face. For example, in Harare, our colleagues from Africa stressed to us that while under-nutrition and food security remain key problems, diet-related chronic diseases co-exist and are on the rise. And Africa is the only one of our six regions where infectious diseases still dominate – for our other five regions, chronic diseases are the major killers.

In all our five meetings Member States reiterated that civil society must play a key role. A strong, effective and coordinated civil society response is vital to any change in countries, especially in the developing world.

Once this consultation process concludes, we will focus on drafting the Strategy, with guidance from our expert reference group. The Strategy will be presented to our Executive Board in January 2004, but a draft will be made available for comment by all stakeholders in the late fall. We are making this process as transparent and inclusive as possible.

But formulating a strategy does not mean that we have solved the problem. Our relationship with you becomes increasingly important as we engage more closely with the private sector and as the debate progresses. We know that often most of the policy and awareness is achieved during the public discourse on these issues. This has clearly been the case with tobacco.

Your active participation in the debate is key to such progress. There are gaps in our knowledge on consumer policy issues and we look to you to provide vital input to the strategy on these areas.

Tomorrow you will be providing your input to the global strategy and we look forward to considering your valuable advice.

I am here to listen. WHO invited you here because we wish to get your input on what you believe to be achievable, on how we can better focus our resources, on where the dangers and pitfalls lie. We are very pleased to be working with you to effect what is potentially one of the biggest positive shifts in population health ever undertaken.